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Jun 21

Bipolar Disorder and Anosognosia


One of the biggest problems in the treatment of bipolar disorder is that many people aren’t aware they are ill. This lack of awareness, termed anosognosia, can be a major barrier that keeps some people with bipolar disorder from getting the treatment they need. In their minds, they’re not sick, so why take medication?

Anosognosia in Bipolar Disorder

It is estimated that around 40 percent of people who have bipolar disorder also have anosognosia. In fact, anosognosia is the primary reason why those with this disease do not take their bipolar medications. Anosognosia is even more common in people who have delusions or hallucinations associated with their bipolar disorder. When people with anosognosia have a hallucination or delusion, they believe that what they are seeing or thinking is real, and are not convinced that an illness is causing these symptoms.

Many people with bipolar disorder have anosognosia that comes and goes, and anosognosia is often not a problem during periods of bipolar remission. But when a bipolar episode hits, they cannot grasp that they have an illness.

Anosognosia is different from denial, which is a common psychological tool people use to suppress the painful emotions associated with an illness or another stressful event. Instead, anosognosia is thought to be caused by damage to the brain, particularly the frontal and parietal lobes of the brain’s right hemisphere. The right hemisphere of the brain controls thinking skills, and damage can result in a number of problems, including difficulty with reasoning and problem solving.

Anosognosia is not unique to bipolar disorder. It is also seen in schizophrenia, stroke, brain tumor, Alzheimer’s disease, and Huntington’s disease.

Bipolar Disorder and Anosognosia: Coping Tips for Caregivers

As the caregiver for someone with bipolar disorder, you play a major role in your loved one’s life.

The patient “really need[s] to have a reliable care partner,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says it is critical for someone with bipolar disorder to have somebody who can help the patient follow the treatment plan, especially when he is ill and cannot do it on his own.

Here are some ways to encourage your loved one to stick with prescribed bipolar treatment:

By Krisha McCoy When his mood is stable, tell him that studies show that people with bipolar disorder can improve with medication. Without medication, the odds of him getting sicker increase, which in turn increases the risk of hospitalization, incarceration, suicide, violent behavior, and becoming a victim of violence.
Developing a partnership with the patient is vital. And that means listening to your loved one’s fears, whether those fears revolve around the diagnosis or being hospitalized against his will.
Empathize; don’t dismiss his opinions or emotions. Get the patient to talk about what is going on, person to person.
Pay more attention to what she thinks is important, not what you think. As the caregiver, you might think that the hallucinations are a huge deal, but your loved one might think lack of sleep is the biggest problem. Discuss her problem; it will help develop trust.
Together, plan how to deal with an acute bipolar episode, especially when anosognosia is an issue.
Don’t get discouraged if you cannot convince her that she has an illness. Focus on helping her stick to her prescribed treatment. The patient might take the medications if you help her remember some of the negative experiences that occurred when she skipped medications before.

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